Implementation of a physician assistant/hospitalist service in an academic medical center: impact on efficiency and patient outcomes.
BACKGROUND
Accreditation Council on Graduate Medical Education (ACGME) duty hour restrictions have led to the widespread implementation of non-house staff services in academic medical centers, yet little is known about the quality and efficiency of patient care on such services.


OBJECTIVE
To evaluate the quality and efficiency of patient care on a physician assistant/hospitalist service compared with that of traditional house staff services.


METHODS
Retrospective cohort study.


METHODS
Inpatient general medicine service of a 747-bed academic medical center.


METHODS
A total of 5194 consecutive patients admitted to the general medical service from July 2005 to June 2006, including 992 patients on the physician assistant/hospitalist service and 4202 patients on a traditional house staff service.


METHODS
A geographically localized service staffed with physician assistants and supervised by hospitalists.


METHODS
Length of stay (LOS), cost of care, inpatient mortality, intensive care unit (ICU) transfers, readmissions, and patient satisfaction.


RESULTS
Patients admitted to the study service were younger, had lower comorbidity scores, and were more likely to be admitted at night. After adjustment for these and other factors, and for clustering by attending physician, total cost of care was marginally lower on the study service (adjusted costs 3.9% lower; 95% confidence interval [CI] -7.5% to -0.3%), but LOS was not significantly different (adjusted LOS 5.0% higher; 95% CI, -0.4% to +10%) as compared with house staff services. No difference was seen in inpatient mortality, ICU transfers, readmissions, or patient satisfaction.


CONCLUSIONS
For general medicine inpatients admitted to an academic medical center, a service staffed by hospitalists and physician assistants can provide a safe alternative to house staff services, with comparable efficiency.
Roy
Christopher L
CL
Department of Medicine, Division of General Medicine and Primary Care, Hospitalist Service, Brigham & Women's Hospital, Boston, Massachusetts 02115, USA. croy@partners.org
Liang
Catherine L
CL
Lund
Maha
M
Boyd
Catherine
C
Katz
Joel T
JT
McKean
Sylvia
S
Schnipper
Jeffrey L
JL
D000046:Academic Medical Centers / Q000458:organization & administration / Q000592:standards*; D000293:Adolescent; D000328:Adult; D000368:Aged; D017598:Efficiency, Organizational; D005260:Female; D006746:Hospital Bed Capacity, 500 and over; D017721:Hospital Costs; D017052:Hospital Mortality; D020445:Hospitalists / Q000592:standards*; D006801:Humans; D007297:Inpatients / Q000523:psychology; D007388:Internal Medicine / Q000458:organization & administration / Q000592:standards*; D007902:Length of Stay; D008297:Male; D008505:Medical Staff, Hospital / Q000592:standards*; D008875:Middle Aged; D009511:New England; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D010823:Physician Assistants / Q000592:standards*; D015397:Program Evaluation; D012189:Retrospective Studies